Dave Panana, BSN

Dr. Lindsey Marvel, OD

Dr. Cynthia E. Guzmán, PhD

Departments

• Dental

• Audiology

• Public Health Nursing

• Optometry

• Primary Care

• Nephrology

• Pediatrician

• Dietician

• Physical Therapist

• Podiatrist

• Ob/Gyn

• Wound Care Clinic

• Behavioral Health

• Pharmacy

• Lab

• Purchased & Referred Care (PRC)

Dr. Lindsey Marvel, OD & Dave Panana, BSN

• Introductions

• Timeline/History of Services

• Strategy for Expansion

• Collaboration with SEVA Foundation

Prior to 638

• Multiple providers

1-2x/month

• Dilated eye exam

• Send out for glasses/contacts

• No diagnostic screenings

• 1 exam room

638 Transition

• 1 FTE Optometrist

• Dilated eye exam

• Send out for glasses/contacts

• No diagnostic screenings

• 1 exam room no additional

staff

• January 2014 dispensing

contacts

• Hire needed staff

• Expand office space

• Expand services &

screenings

• Expand Network &

Contracts

• Hired 1 FTE optometry

tech

• Obtained additional

office space

• Added frames for

dispensing

• Expanded contracts

• VSP

• Buy-in Group

• Renovations

• Expanded to 2 exam lanes

• Diagnostic room

• Provider office space

• Optical shop

• Equipment

• Retinal Camera

• OCT

• 2nd exam room equipment

• Optical shop needs

• SEVA Collaboration

• Corneal topographer

• Auto-refractor

• $45,000 of equipment &

billable services

• Readers/diabetic eye

glasses

• Low vision equipment

• Low vision is visual impairment due to eye disease

• Condition cannot be improved with eyeglasses, contact lenses, medication, or eye surgery

• Patients are fit with devices that help them perform task specific goals

• Low Vision in VA (department of veterans affairs)

• Low vision services rare in IHS and devices not covered

• Optometrists find low vision exams time consuming and requiring a lot of calculations

• Eschenbach training

• Incorporating low vision in a primary eye care setting

• E and M codes used for billing- Insurance often doesn’t cover exam or devices

• Low vision patients still need routine eye care and this is billable

• Seva/PRC as a funding source for low vision devices

• Damage of blood vessels in the back of the eye

• A leading cause of blindness in American adults

• Ways to detect diabetic eye disease

• Telehealth in eye care limited in the US

• India/Aravind

• JVN

• Need for a dedicated imager

• Retinal photography billable service

• Report also billable

• Reaching out to other tribes through telehealth

532

1677

1957

2396

0

500

1000

1500

2000

2500

3000

2013 2014 2015 2016

Dave Panana, BSN & Cynthia E. Guzmán, PhD

• Scope of Work

• Budget Assessments

• CMS TTAG Project

• Opportunities for Advocacy

Scope of Work

• Individual Therapy

• Group Therapy

• Family/Couples Therapy

• Evaluations

• Outreach

• Education & Coaching

• Psychopharmacology

• Psychiatry

• Consultation

Clinical Staff

• Licensed Psychologists (2)

• Psychiatrist (1)

• Masters Level Counselor (1)

• Substance Abuse Counselor (1)

• Federal funding vs Third party

• Assessing needs and opportunities for growth

• Estimating clientele growth needed/anticipated

• Prioritizing where to expand next, needs assessment

• Ensuring that you are receiving reimbursements for services

• Behavioral Health Subcommittee

• Overview of the State Plans Project

• Reimbursement Rates across the US

• OMB rate vs Fee schedule or Zero Revenue

• TTAG

• Local representative

• Tribal Consultation

Contact Information

Dave Panana, BSN

• Health Center Director – dpanana@kp-hc.org

Lindsey Marvel, OD

• Optometrist – lmarvel@kp-hc.org

Cynthia E. Guzmán, PhD

• Behavioral Health Program Manager – cguzman@kp-hc.org